One of two things can be responsible for the absence of sperms in the ejaculate:
1. The testicles do not produce enough sperm to be be found in the ejaculate.
2. Sperms are unable to reach the seminal fluid because of congenital absence of the tube that carries sperm from the testes to the seminal fluid. Sperm may be obtained from the epididymis or the testis directly, in cases such as those mentioned previously. The acquired sperm may then be used in an IVF cycle employing ICSI, if the sperms are suitable.Surgical sperm recovery is performed under local or general anesthesia.